Prognosis improves for public insurance

Democratic leaders in the Senate and House have concluded that a government-run insurance plan is the cheapest way to expand health coverage, and they sought Friday to rally support for the idea, prospects for which have gone in a few short weeks from bleak to bright.

The shift in momentum is so dramatic that many lawmakers now predict that President Obama will sign a final bill that includes some form of government-sponsored insurance for people who do not receive coverage through the workplace. Even Democrats with strong reservations about expanding government's role in the health-care system say they are reconsidering the approach in hopes of making low-cost plans broadly available.

Senate Majority Leader Harry M. Reid (Nev.) and House Speaker Nancy Pelosi (Calif.) sought support Friday for expansive versions of the public option as they prepared to send reform legislation to the Senate and House floors. Their goal is to pass bills with similar versions of the public insurance option so that final talks between the two chambers can focus on other issues that could prove more difficult to resolve.

The public option emerged as a flash point in the reform debate at the outset, with liberals championing it as a precursor to a single-payer system and conservatives warning that it would lead to rationing. The rhetoric reached a fever pitch in hundreds of raucous town-hall meetings during the August congressional recess, leading Democrats -- including Obama -- to back off the idea for fear that it would sink overall reform legislation.

On Friday, congressional leaders marveled at how quickly the landscape has changed. "This is an exact quote: 'Off the table,' " House Majority Whip James E. Clyburn (S.C.) said, recalling the headlines earlier this month when the Senate Finance Committee rejected two versions of the public option in its reform bill.

Clyburn said the debate is no longer whether to include a public option, but "whether or not we will get this form of a public option or that form of a public option." Since the talk of "death panels" at town-hall meetings in August, Clyburn said, the political climate has changed as voters have come to understand "that all of this foolishness was just that -- foolishness. Nobody wants to pull the plug on Grandma."

Frustrating to some

The public-option debate is frustrating some Democrats, who have come to believe that a government-run plan is neither as radical as its conservative critics have portrayed, nor as important as its liberal supporters contend. Any public plan is likely to have a relatively narrow scope, as it would be offered only to people who don't have access to coverage through an employer.

The public option would effectively be just another insurance plan offered on the open market. It would likely be administered by a private insurance provider, charging premiums and copayments like any other policy. In an early estimate of the House bill, the Congressional Budget Office forecast that fewer than 12 million people would buy insurance through the government plan.

Sen. Mary Landrieu (La.), a moderate Democrat, said she still opposes a national plan financed by the federal government but would consider other permutations of a public plan, including a provision Reid is circulating to establish an "opt-out" clause for states that don't want to participate. "There is a way to compromise this, I believe," she said. "The goal is not public or private. The goal is choice and affordability."

Reid's strategy is to try to persuade his Democratic caucus to allow a health-care bill with an opt-out public plan to come to the floor, even if there is no guarantee that all 60 senators who caucus with Democrats would ultimately vote for it. All 40 Senate Republicans, including Sen. Olympia J. Snowe (Maine), who supported the Finance Committee bill, have pledged to block legislation that includes a government insurance plan. Reid must unite Democrats to break that filibuster.

"He's knows what he's doing is a gamble," Reid spokesman Jim Manley said. "But more and more, he's convinced it's the right thing to do."

Reid's calculation is that it could be more difficult to add a public option through amendments on the Senate floor than to include it in the bill and force opponents to try to find the votes to strip it out. Manley said Reid would spend the weekend canvassing Democrats on the opt-out idea and would probably decide Monday whether to include it in the Senate bill.